Pitfalls to avoid when introducing a cultural competency training initiative.

OBJECTIVES In an effort to provide preventive advice, this paper aims to acknowledge what has not worked with regard to cultural competency initiatives. A successful cultural competency training initiative should have lasting impact on its participants in terms of long-term, ideally permanent changes to attitudes, knowledge and skills resulting in the provision of optimum care, regardless of a patient's cultural background. Legal mandates mean there is an assumed need for cultural competency curricula and training programmes for medical students and postgraduate medical trainees. However, policy and practice have bypassed 'proof' that such programmes are effective and result in better patient care. Often only positive results are reported, which may minimise the difficulties involved in programme implementation. METHODS Utilising the example of a cultural competency initiative introduced into a postgraduate general surgery training programme, this paper discusses mistakes that were made during the implementation phase, particularly with regard to underestimating potential resistance by the trainees. Also presented are the lessons learned and efforts that were made to mitigate the problems that arose. None of what is discussed in this paper is new. However, the literature often does not discuss in detail the difficulties that can be or have been faced and how these obstacles can be adequately mitigated. CONCLUSIONS The glow of cultural competency training initiatives is fading in the light of higher expectations for an evidence base prior to acknowledgement that their introduction has had a positive impact. For these initiatives to advance, there needs to be a clear understanding of terms utilised, buy-in and a long-term commitment at both individual and organisational levels, and use of standardised and validated tools to measure outcomes. An understanding of potential pitfalls can help to advance cultural competency training to the next level, namely, a solid evidence base that justifies both an individual's and an institution's investment in this effort.